1942245360 NPI number — KEYSTONE REHABILITATION SYSTEMS INC

Table of content: (NPI 1942245360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942245360 NPI number — KEYSTONE REHABILITATION SYSTEMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEYSTONE REHABILITATION SYSTEMS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942245360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1245
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15701-5245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-465-3496
Provider Business Mailing Address Fax Number:
215-413-4682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
258 STATE ROUTE 14
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
COLUMBIANA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44408-9476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-482-6114
Provider Business Practice Location Address Fax Number:
330-482-6115
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDBERG
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CHIEF COMPLIANCE OFFICER
Authorized Official Telephone Number:
610-644-7824

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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